Assumption of Responsibility - Cremationist (Crematory)

A.R.S §32-1333 A Cremationist must notify the Department of Health Services in writing within five business days after a change in employment, excluding Saturdays, Sundays and other legal holidays.

Crematory

Name of Crematory

Crematory License #

Address

City/Town

State/Province

ZIP/Postal Code

Cremationist

Previous Responsible Cremationist First Name

Previous Responsible Cremationist Last Name

New Responsible Cremationist First Name

New Responsible Cremationist Last Name

Email

You will need to confirm your submission through this email.

License Number

Update Point of Contact Email Address

Yes

No

New Point of Contact email - All Board notifications will go to this email address

NOTE: There can only be one POC email address and all Board notifications will be sent to the designated POC only

Effective Date

R4-12-612. Crematory requirements, in addition to the requirements in A.R.S. § 32-1394, the responsible cremationist of a crematory shall ensure:

The crematory is maintained free from dirt and debris,
Equipment and supplies maintained in the crematory do not impede passage through the crematory, and
Human remains that are not embalmed are held in a refrigerated holding facility at the crematory or sent to a funeral establishment or another crematory for refrigeration.

R4-12-631. Records requirements for crematories and funeral establishments that provide for cremation. (Refer to the rule for more information.)

I hereby affirm that I am duly licensed as a Cremationist in the State of Arizona and reside therein. I am familiar with the laws of Arizona and the rules and regulations of the Department of Health Services as it relates to funeral establishments. I affirm that the crematory will be equipped, operated and maintained in accordance with the provisions of such laws and regulations. A.R.S § 32-1394. A crematory licensed pursuant to this article shall maintain a retort that is operated at all times in a sanitary and professional manner, that conforms to local building and environmental codes and that provides protection for the health and safety of persons in attendance at a cremation and employees of the crematory. Maintain a holding facility that is secure from access by anyone other than employees of the crematory and public officials in the performance of their official duties, that complies with applicable public health laws, and that preserves the dignity of human remains in the facility. Possess all equipment and supplies that are necessary to conduct cremations. Employ and designate a responsible cremationist who is licensed pursuant to this article and who is trained in crematory operations to manage the daily operation of the crematory. As a responsible cremationist, I understand that I am responsible to the Arizona Department of Health Services for a crematory complying with the laws and regulations and hereby accept responsibility for the crematory named above.

I agree - I understand that by signing, my electronic signature is the legal equivalent of my handwritten signature and I consent to be legally bound to this agreement. I further agree my signature on this document is as valid as if I signed the document in writing. Under penalty of perjury, I herewith affirm that my electronic signature was signed by myself with my full knowledge and consent.

Signature

Sign above